Posterior stabilized mobile bearing knee

ABSTRACT

A knee prosthesis and method for use are provided, in which the knee prosthesis provides anterior and posterior stability and controlled femoral roll-back, while also providing rotational kinematics. The femoral component has a pair of convexly shaped condyles which are spaced apart to form an intercondylar notch. Anterior and posterior cams are provided within the notch. The tibial component comprises a platform upon which a tibial bearing is mounted to provide for rotational movement about the tibial axis. The tibial bearing is provided with surfaces to engage the condyles and has an upwardly extending spine which is positioned to engage the anterior and posterior femoral cams. At full extension, the spine engages the anterior femoral cam to provide a 3° hyperextension stop. Between full extension and approximately 50° of flexion, the spine is free to translate between the anterior and posterior femoral cams. From 50° to 120° of flexion, the spine engages the posterior femoral cam, which provides femoral roll-back and posterior stability.

CROSS-REFERENCE

This application is a continuation of U.S. patent application Ser. No.09/395,584, filed on Sep. 14, 1999, now U.S. Pat. No. 6,443,991, whichin turn claims the benefit of both (i) U.S. Provisional PatentApplication Ser. No. 60/127,929, filed on Apr. 6, 1999, and (ii) U.S.Provisional Patent Application Ser. No. 60/101,312, filed Sep. 21, 1998,the disclosures of each of these three patent applications are herebyincorporated by reference for all purposes in their entirety.

BACKGROUND AND SUMMARY OF THE INVENTION

The present invention relates to a knee prosthesis and more particularlyto the provision of a knee prosthesis comprising a rotating bearing onthe tibial platform with a spine for posterior stabilization of theanterior-posterior translation of the femoral component relative to thetibial component.

The prior art includes various examples of knee prostheses. Examples ofposterior stabilized knee prostheses can be found in U.S. Pat. Nos.4,298,992 and 5,147,405. Also, examples of knee prostheses which providea rotational bearing can be found in U.S. Pat. Nos. 4,470,158 and5,395,401. These references are incorporated herein by reference.

The present invention provides a knee prosthesis comprising a femoralcomponent adapted to be implanted on the condylar portions of the femurand having a pair of laterally spaced-apart condylar portions, each ofwhich has an external surface that is preferably smoothly convexlycurved in the antero-posterior direction and generally matches theshapes in lateral profile of condylar surfaces of the femur. Thesecondylar surfaces are preferably smoothly convexly curved in allcross-sections along their antero-posterior extent, and theintercondylar portion connecting the condylar portions defines anintercondylar notch having spaced-apart lateral surfaces or walls. Thisintercondylar notch may preferably be a box-like housing havingspaced-apart lateral side walls and an open roof. Within this notch, thefemoral component preferably provides an anterior femoral cam and aposterior femoral cam. The prosthesis further comprises a tibialcomponent adapted to be implanted on the tibial platform and including abearing having on its superior surface a pair of laterally spaced-apartconcavities or bearing surfaces, each of which is adapted to receive innested relation one of the condylar portions of the femoral component.This bearing is preferably formed to include a superior extending spineto be received in the intercondylar notch of the femoral component. Thespine preferably has lateral surfaces, an anterior tibial cam, and aposterior tibial cam. A platform is provided to be rigidly attached tothe proximal end of the tibia to provide a surface upon which thebearing rotates about an axis generally aligned with the tibia.

In the illustrated embodiment, the relative positions and shapes of thespine and the intercondylar notch of the prosthesis as implanted intothe knee joint are such that, when the leg is at or near full extension,where the femur tends to dislocate posteriorly relative to the tibia,the anterior femoral and tibial cams engage each other to preventposterior dislocation of the femoral component. When the leg is partlyflexed, the femoral and tibial cams are spaced-apart from each other andpermit relatively free antero-posterior translation of the componentsbut are available to restrain excessive anterior and posteriormovements. From approximately 40° to 60° of flexion to approximately120° of flexion, the posterior femoral and tibial cams engage and bearon each other. Preferably, the posterior cams engage from approximately50° to approximately 120° of flexion. During this flexion, the tibialcam prevents the femoral component from moving anteriorly, and thetibio-femoral contact shifts posteriorly. This femoral roll-backtheoretically provides for increased range of motion and improvedquadriceps efficiency at deeper flexion angles. Further, preferably, therelative positions and shapes of the posterior femoral and tibial camsof the prosthesis as implanted in the knee joint are such that, when theleg approaches full flexion, the tibial cam is of sufficient height toprevent anterior dislocation of the femoral component.

The present invention also provides a method for controlling theantero-posterior translation of a knee prosthesis comprising the stepsof providing a femoral component and attaching the femoral component toa femur at its distal end. The femoral component has condyle surfaceswhich are spaced apart to define a notch therebetween and a femoralanterior cam and a femoral posterior cam disposed in the notch. A tibialcomponent is provided to be attached to the tibia at its proximal endand the tibial component comprises a platform to be attached to thetibia and a bearing mounted on the platform for rotational movementabout an axis extending generally in the direction of the tibia. In themethod of the present invention, the bearing is formed to providebearing surfaces for movably supporting the femoral component condylesurfaces. The bearing is also provided with a spine extending superiorly(upwardly) into the notch between the condyle surfaces. This spine isprovided for engaging the femoral anterior posterior cams to provideanterior and posterior stability and femoral roll-back. Also, the spineis of sufficient size to provide an adequate subluxation height. Thetibial anterior cam preferably inclines upwardly from the anteriorportion of the bearing, and the tibial posterior cam preferably inclinesdownwardly from the peak at a point adjacent the axis of rotation of thebearing and generally parallel to the rotational axis.

The illustrative tibial anterior cam surface inclines upward slightlyfrom the anterior most portion of the bearing to a point at which theinclination is about 40° to 50° up to the peak of the spine. Theillustrative femoral anterior cam is convexly curved to have a curveportion generally aligned with the more inclined portion of the tibialanterior cam from said point to the peak when the knee is at fullextension. The femoral posterior cam is also convexly curved, and it isplaced to engage the tibial posterior cam when the knee is at about 40°to 60° of flexion, preferably at about 50° of flexion. At that point,the tibial posterior cam prevents the femoral component from furtheranterior translation. From 40° to 60° of flexion to 120° of flexion, thefemoral posterior cam continues to engage the tibial posterior cam, androll-back occurs during such flexion. Preferably, a spine is provided ofsufficient height to reduce the possibility of dislocation fromapproximately 90° to 120° of flexion.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of the knee system of the present inventionshowing the femoral component and the tibial component with the tibialbearing;

FIG. 2 is an elevation view from the anterior of FIG. 1;

FIG. 3 is a side view of the assembly shown in FIGS. 1 and 2;

FIG. 4 is an exploded side view showing the plastic bearing elementremoved from the tibial platform;

FIG. 5 is a perspective view of the femoral component;

FIG. 6 is a perspective view of the upper portion of the bearingcomponent;

FIG. 7 is a diagrammatical side view showing the knee at full extension;

FIG. 8 is a diagrammatical side view showing the knee at 120° flexion;and

FIG. 9 is a diagrammatical view showing the subluxation height permittedby the system of FIG. 1.

DETAILED DESCRIPTION OF THE DRAWINGS

Referring specifically to FIG. 1, it will be seen that a knee system 10of the present invention comprises a femoral component 12 and a tibialcomponent 14. The tibial component 14 comprises a tibial platform 16from which a tibial stem 18 extends downwardly, and a bearing 20 whichmounts on platform 16. As indicated in FIGS. 3 and 4, the tibialplatform 16 is provided with a socket 26 extending downwardly from anopening 17 in the platform, for receiving a stem 28 which extendsdownwardly from the bearing 20. Also as shown in FIGS. 3 and 4, the stem28 of bearing 20 is provided with a generally cylindrical portion 30,which rotatably seats in a generally cylindrical portion 32 of socket26, and stem 28 terminates in a distal tapered portion 24, which seatsin a mating distal tapered portion 22 of socket 26. However, it will beunderstood that stem 28 and socket 26 need not be provided with suchcylindrical and tapered portions. Other mounting configurations whichallow for relatively free rotational movement are within the scope ofthis invention.

As best seen in FIG. 1, the illustrative tibial stem 18 is provided withradially spaced-apart, downwardly extending ridges 34 which extendtoward a distal tip 36 of the stem and which terminate as indicated at38. These radially spaced-apart ridges 34 serve to anchor the tibialcomponent 14 in the tibia against rotation about the axis of the stem18. It is well known that the stem 18 may be provided with a porousmetal coating into which the bone of the tibia will grow to hold thetibial component in position in the tibia. It is also well known thatthe tibial component 14 may be cemented within the tibia. Otherconfigurations and techniques for anchoring tibial component 14 to atibia are known and are within the scope of this invention. The tibialplatform 16 provides an upper platform surface 40 which serves as abearing surface to support a bottom surface 42 of the bearing 20. Thebearing 20 is permitted to rotate about the axis 21 (see FIGS. 3 and 4)of its stem 28 which is received in the socket 26. Such bearings areknown as rotary bearings in that the bearing 20 can move rotationallyrelative to the tibial platform 16 which is anchored to the tibia.

Referring to FIG. 6, the perspective view of the upper portion of thebearing 20, it will be seen that the bearing 20 is provided with bearingsurfaces 50, 52 for supporting condyle bearings 84, 86 of the femoralcomponent 12. Bearing surfaces 50, 52 may be configured in a number ofmanners, such as those disclosed in U.S. Pat. Nos. 4,309,778, 4,340,978,and 4,470,158, which are hereby incorporated by reference. A spine 60,sometimes referred to as an eminence or post, is located between thebearing surfaces 50, 52 and is provided with sides 62, 64 extendingupwardly. The spine 60 is also provided with an anterior tibial cam 66,a posterior tibial cam 68, and a peak 58 therebetween. A ramp 74 islocated posteriorly of the spine 60 to incline upwardly to a posteriorend 56, as best seen in FIG. 4. The posterior tibial cam 68 of the spine60 and the ramp 74 join to provide a notch or smooth transition 76, alsobest seen in FIG. 4. Referring further to FIG. 4, it will be seen thatthe anterior tibial cam 66 is a ramp-like surface beginning near theanterior portion of the bearing 20 and ramping upwardly and rearwardlyto the peak of the spine 60. Initially, near an anterior end 54 of thebearing 20, the anterior tibial cam 66 inclines slightly upwardly, andfurther back the anterior tibial cam 66 includes a surface 66 a inclinedat an angle α of about 40° to 50° relative to plane x. Plane x may bethought of as coincident with surface 42 of bearing 20 that contactsplatform 16 or, alternatively, may be thought of as a plane generallyperpendicular to the axis of stem 28. Alternatively, if the prosthesisis implanted in a patient whose leg is positioned at full extension asshown in FIG. 7 on a flat level surface, plane x may be thought of asparallel to that flat level surface. In the illustrative embodiment ofFIG. 4, angle α is about 45°.

In the illustrative embodiment, posterior tibial cam 68 is essentiallyplanar and extends essentially linearly in the proximal-distal directionfrom peak 58 to transition 76. In particular, as shown in the sideelevational views of FIGS. 3 and 4, the posterior tibial cam 68 definesa vertically extending line 67 which is arranged to be coincident with,or otherwise coaxially arranged with, the rotary axis 67 of the bearing20. However, posterior tibial cam 68 may be curved in any number of waysand still provide a suitable surface for providing roll-back andposterior stability. Such alternative spine configurations are withinthe scope and spirit of this invention.

As best seen in FIG. 5, the femoral component 12 is conventionallyformed to have an anterior portion 80 and a posterior portion 82providing condyles or condyle bearings 84, 86 for movably engagingbearing surfaces 50, 52 of the bearing 20. Preferred embodiments may befound in the '778 and '978 patents, which were discussed above andincorporated by reference. Conventionally, the femoral component 12 maybe made from a suitable metal, while the bearing 20 may be made from aplastic material such as ultra high molecular weight polyethylene(UHMWPE). The prior art references referred to above describe the natureof the acceptable prosthesis implant metals and plastics. The condylebearings 84, 86 will have radii of curvature to provide appropriatecontact between the femoral component 12 and tibial component 14 asdiscussed in the prior art. It will be appreciated that, while at fullextension as depicted in FIG. 7, the condyle bearings 84, 86 are morecongruent with the bearing 20 surfaces 50, 52 than when the knee is at120° of flexion, as depicted in FIG. 8. At 120° of flexion, only theposterior-most portion of the condyle bearings 84, 86 will be in contactwith the bearing 20 surfaces 50, 52, and the contact point will beshifted posteriorly.

It will further be appreciated that in typical knee action, there isconsiderable anterior-posterior movement of the femoral component 12 onthe tibial component 14, the anterior direction being represented by thearrow “A” and the posterior direction being represented by the arrow “P”in the drawings. According to this invention, this translation of thefemoral component 12 relative to the tibial component 14 is controlledas the knee moves between full extension and full flexion. This controlis provided by the spine 60 with its cams 66, 68. Specifically, thespine 60 extends upwardly into an intercondylar notch 88, which islocated between condyle bearings 84, 86 in femoral component 12. Insidethis intercondylar notch 88 is an anterior femoral cam 100 and aposterior femoral cam 102 for engaging, respectively, the anteriortibial cam 66 and posterior tibial cam 68 of the spine 60. Thisrelationship is best seen in FIG. 3 and FIGS. 7-9. As best seen in FIG.3, the anterior femoral cam 100 on femoral component 12 is convex andextends distally from the anterior portion of a roof 110 of theintercondylar notch 88, as best seen in FIG. 3 and in FIGS. 7-9.Likewise, the posterior femoral cam 102 on femoral component 12 issimilarly convex and extends distally from the posterior part of roof110 of the intercondylar notch 88.

As best seen in FIG. 5, interior walls 92, 94 of the intercondylar notch88 are provided by a cam housing formed by sides 106, 108 and roof 110which illustratively has a square aperture 112 formed therein. Thefemoral component 12 may be cemented to the resected femur or thefemoral component may be coated with a porous material for boneingrowth. Alternatively, a stem-like fastening component (not shown) mayextend upwardly through aperture 112 to secure femoral component 12 tothe femur. In a preferred embodiment, shown in FIG. 1, the flat roof maybe omitted, and a proximal end 130 of the intercondylar notch 88 may bedefined only by a proximal surface 122 of anterior femoral cam 100, aproximal surface 124 of posterior femoral cam 102, a proximal edge 126of side 106, and a proximal edge 128 of side 108. It will be understoodthat this preferred configuration provides additional space for spine 60without resecting additional bone.

The manner in which the femoral component 12 may be mounted on thedistal end of a femur is well known and need not be described in detailfor those skilled in the art.

In operation, the anterior femoral cam 100 and posterior femoral cam 102of the femoral component 12 articulates with the spine 60 on the tibialbearing 20 to provide posterior stability. Stated alternatively, thespine 60 articulates with anterior femoral cam 100 and posterior femoralcam 102 of femur component 12 to provide stability. In the fullyextended position of FIG. 7, the anterior tibial cam 66 of spine 60engages with the anterior femoral cam 100 to provide, for example, a 3°hyperextension stop. The posterior tibial cam 68 of spine 60 engagesposterior femoral cam 102 at about 40° to 60° of flexion, preferably atabout 50° of flexion. Normal weight bearing gait involves flexion anglesof approximately 40° or less. Thus, for the weight bearing phase ofwalking, the spine 60 does not engage the posterior femoral cam 102.During activities involving flexion angles greater than about 40° to60°, such as stair climbing or rising from a chair, the posterior tibialcam 68 of the spine 60 engages the posterior femoral cam 102, providingposterior stability and femoral roll-back, as depicted in FIG. 8.Femoral roll-back is the posterior shift of the tibio-femoral contactpoint as the knee bends from full extension (FIG. 7) to deep flexion(FIG. 8). As illustrated, the knee system 10 provides for approximately11 mm of femoral roll-back on a medium sized prosthesis. Preferably,this roll-back, combined with the rotary feature, provides continuousmedial and lateral contact between the femoral and tibial bearingssurfaces.

One element considered in the design of the traditional posteriorstabilized knees is the subluxation height. This is defined as thedistance the femoral component 12 must raise up to sublux or jump overthe top of tibial spine 60 during flexion (FIG. 9), the maximumsubluxation being indicated at 116. As shown in FIG. 9, maximumsubluxation 116 is the distance from a distal-most portion 118 of thefemoral component 12 to a corresponding location 120 on bearing surface50 that femoral component 12 would ordinarily engage at full roll-back.Of course, when the condition depicted in FIG. 9 occurs, dislocation mayoccur if laxity of collateral ligaments in flexion allows the kneeprosthesis to exceed the subluxation height of the design. For example,for a medium sized prosthesis, a subluxation height 116 of 15.4 mm at90° and 14.5 mm at 120° of flexion (deep flexion is when the dislocationcomplication occurs) may be suitable. It will be seen that subluxationheight 116 is measured from the point indicated at 118 on the condylebearing 84 to the location 120 on the bearing surface 50.

The surgery techniques for installing the knee system 10 of the presentinvention may be similar to well known surgical techniques used forinstalling knees with rotating platform or deep dish bearing components.It will be clear that an exception to this is that the trochlearrecessing cut made with the finishing guide for the femur may be cutdeeper to provide clearance in the distal femoral bone for theintercondylar notch 88 of the femoral component 12. The largerintercondylar notch 88, in turn, accommodates a taller tibial spine 60,which provides the larger subluxation height.

Although the present invention has been shown and described in detail,the same is by way of example only and not by way of limitation.Numerous changes can be made to the embodiments shown and describedwithout departing from the spirit and scope if the invention.Accordingly, the present invention is to be limited only by the terms ofthe claims appended hereto.

What is claimed is:
 1. A method for providing anterior and posteriorstabilization and femoral roll-back to a knee with a knee prosthesishaving a rotating tibial bearing, the method comprising the steps of:attaching a femoral component to the distal end of a femur, the femoralcomponent having condyle surfaces shaped to permit femoral roll-back,the femoral component further having an anterior stabilization mechanismand a posterior stabilization mechanism; attaching a tibial component tothe proximal end of the tibia, the tibial component supporting thetibial bearing which is provided to engage the condyle surfaces; andproviding a spine on the tibial bearing which is positioned to cooperatewith the anterior stabilization mechanism and the posteriorstabilization mechanism, wherein the spine engages the anteriorstabilization mechanism at full extension to provide a 3° hyperextensionstop.
 2. The method of claim 1, in which the spine engages the posteriorstabilization mechanism at approximately 50° of flexion and femoralroll-back occurs between 50° and 120° of flexion.
 3. The method of claim2, in which the spine provides a subluxation height of approximately 15mm at 90° flexion.
 4. The method of claim 3, in which the spine alsoprovides a subluxation height of approximately 14 mm at 120° flexion. 5.A knee prosthesis comprising: a femoral component to be attached to afemur at its distal end and having condyle surfaces spaced apart todefine a notch therebetween and having an anterior femoral cam and aposterior femoral cam disposed in the notch; and a tibial component tobe attached to a tibia at its proximal end and comprising a platform forattachment to the tibia and a bearing having an anterior portion and aposterior portion, the bearing mounted on the platform for rotationalmovement about an axis extending generally in the direction of thetibia, wherein the bearing having bearing surfaces for supporting thecondyle surfaces and having a spine for extending upwardly into thenotch, the spine having an anterior tibial cam for engaging the anteriorfemoral cam, a posterior tibial cam for engaging the posterior femoralcam, and a peak between the anterior and posterior tibial cams, theanterior tibial cam inclining upwardly from the anterior portion of thebearing and the posterior tibial cam inclining downwardly from the peakat a location adjacent the axis of rotation of the bearing and generallyparallel to the axis, and wherein the posterior femoral cam is convexlycurved and placed to engage the posterior tibial cam when the knee is atabout 40° to 60° of flexion, and the femoral component is shaped toprovide femoral roll-back as flexion increases, and wherein the spineand posterior femoral cam are sized and positioned to provide asubluxation height of approximately 15 mm at 90° of flexion.
 6. The kneeprosthesis of claim 5, in which the tibial bearing comprises ultra highmolecular weight polyethyene.
 7. A knee prosthesis for implantation in aleg of a patient, the knee prosthesis comprising: a femoral component tobe attached to a femur at its distal end and having a pair of convexlycurved condyle surfaces spaced apart to define a notch therebetween, thefemoral component further comprising an anterior femoral cam and aposterior femoral cam which extend into the notch; and a tibialcomponent to be attached to a tibia at its proximal end, comprising aplatform for attachment to the tibia and a bearing mounted on theplatform and rotatable about an axis extending generally in thedirection of the tibia; wherein the bearing having bearing surfaces forsupporting the condyle surfaces, and a spine extending superiorly fromthe platform, the spine positioned and designed to be received in thenotch between the anterior and posterior femoral cams, and to engage theanterior femoral cam at approximately full extension and to engage theposterior femoral cam at approximately 40° to 60° of flexion, whereinthe spine is of sufficient height to provide a subluxation height of atleast 13 mm.
 8. The knee prosthesis of claim 7, wherein the spineengages the posterior femoral cam at approximately 50° of flexion. 9.The knee prosthesis of claim 7, in which the pair of condyle surfacescomprise a medial condyle surface and a lateral condyle surface, and thebearing surfaces comprise a medial bearing surface and a lateral bearingsurface, and further the condyle surfaces and bearing surfaces arepositioned and configured such that the medial condyle surface generallyremains in contact with the medial bearing surface and the lateralcondyle surface generally remains in contact with the lateral bearingsurface from about full extension through about 120° of flexion.